18 Nov 00 - Medicine - Economy class risks 'greater than expected'

Ananova

PA News ... Saturday 18 November 2000

The risk of suffering from fatal blood clotting during a flight or "economy class " syndrome is greater than first thought, a new report has said.

The study of 100 air passengers showed that one in 10 developed a blood clot as a result of flying. Blood clots in the legs can lead to deep vein thrombosis , which kills dozens of airline passengers each year, if the clots work their way to the heart or lungs .

The condition has been labelled "economy class " syndrome because the cramped seats, lack of mobility and dehydration suffered by economy passengers on long-haul flights make it difficult for blood in the legs to flow properly, increasing the chances of a clot.

Speaking on Sky News, author of the report John Scurr said the study was specifically designed to pick up blood clots caused by flying.

He said: "We studied the patients before they went. It was really only because of the flying that there was a difference."

The volunteers, aged 50 and over, were tested before and after their flights. The report follows the death of bride-to-be Emma Christoffersen in October.

The 28-year-old fitness fanatic from Newport, South Wales, died from a blood clot brought on by sitting in a cramped seat for 20 hours of a 10,000-mile journey from Australia.

18 Nov 00 - Medicine - Surgery halted over 'dirty' instruments

By Celia Hall, Medical Editor

Telegraph ... Saturday 18 November 2000

Ten surgeons have told their hospital managers to halt all emergency orthopaedic surgery because continuing problems with sterilising equipment are putting patients' lives at risk .

(UK Correspondent's comment: Foreign readers should be aware that repeated tranches of "New Labour" extra funding for the Health Service have sadly been as ephemeral as the spin surrounding it.)

The Queen Alexandra Hospital in Portsmouth stopped routine hip and knee replacement operations two months ago because of difficulties with the hospital's sterilisation and disinfection unit. Now the frustrated consultant surgeons, faced with an unresolved shortage of sets of surgical equipment, have said that accident surgery must stop as well , in two weeks.

In their letter to Dr Peter Howlett, the chief executive of the NHS trust , the surgeons say: "In order to give our neighbouring units time to accommodate this decision we feel it should take effect on Monday, November 27." The letter says: "We have previously taken the view that cancellation would put the patients at greater risk than continuing the service. We now feel that patients' lives and wellbeing are at serious risk ."

The letter refers to previous requests for action and to a "dangerous delay" in typing notes of patients with fractures. It says: "We are extremely disappointed that concerns brought to your attention in June have not been addressed."

Martin Grover, consultant orthopaedic surgeon, one of the signatories, said yesterday that the problem lay in the supply of sterile equipment . Mr Grover said the difficulty was in not being able to start an emergency operation because of the lack of sterile equipment and concern that surgeons might find they needed another piece of equipment once an operation had started, which was not then available.

He said that patients who have had surgery had not been put at risk. He said: "Our worries started 18 months ago . The sterilising department is overloaded and unreliable. The trust is trying to put things right but it is going to take a long time."

Dr Liam Fox, the shadow health secretary, said the situation was "disgraceful " and that Gisela Stuart, the health minister, should explain the lack of action. He said: "If the minister knew about the potential severity of the problem but failed to take appropriate action then clearly her position will come into question."

A spokesman for the Department of Health said: "The hospital should not have let this situation develop and we expect them to sort out their sterilisation department, to make sure patients are safe and to deal with those who have had to wait for operations. The spokesman said: "If they do not, we will consider action against the hospital managers involved."

A statement from the Portsmouth Hospitals NHS Trust said: "The trust recognises and acknowledges the problems with the Hospital Sterilisation and Disinfection Unit, which it has been actively working on since June. We acknowledge that we have made very slow progress... [but] the trust is working very hard to ensure that orthopaedic trauma surgery continues at the hospital. More instruments have been ordered." A hospital spokesman said they were investing £250,000 in refurbishing the department.

18 Nov 00 - Medicine - Surgeons fear equipment delay may cost lives

By Nigel Hawkes, Health Editor

Times ... Saturday 18 November 2000

Ten surgeons have written to the chief executive of Queen Alexandra Hospital in Portsmouth saying that surgery on accident victims should be halted within a fortnight because of worries over the supply of sterile equipment .

The hospital serves one of the biggest catchment areas in Hampshire, covering 600,000 people.

The hospital's sterilisation unit has not been working properly since June and doctors have become infuriated at the time taken by the management of the trust in resolving the problem.

Last week a patient was taken to the hospital with a multiple fracture which needed surgery, yet the surgeon assigned to the task took six hours to find the necessary sterilised equipment.

Routine orthopaedic surgery was stopped three months ago to ensure that there was enough properly sterilised equipment for emergencies, but surgeons now say they cannot ensure the safety of accident victims .

The move would mean that accident victims who may need vital surgery could not be taken to the accident and emergency department of the hospital. The surgeons' letter says: "Despite stopping elective orthopaedic surgery we have not seen any improvement in the supply of sterile instruments for trauma. Indeed, the situation has become worse.

"We have previously taken the view that cancellation of trauma would put the patients at greater risk than continuing the service.

"But this situation has now changed ... we now feel that patients' lives and wellbeing are at serious risk and this situation cannot be allowed to continue ."

The surgeons also raised concerns about the delay in typing up medical notes of patients who had broken bones. Staff shortages meant that notes from the hospital's fracture clinic took more than two weeks instead of two days to be typed up.

The letter says: "I am sure you will understand our decision has not been undertaken lightly .

"We are extremely disappointed that the concerns brought to our attention have not been addressed .

"Morale in the orthopaedic department is at an all-time low and our concerns have been expressed."

The letter will add to fears that despite unprecedented planning and multimillion-pound investment, the health service is still heading for a damaging crisis this winter .

A statement from the Portsmouth Hospitals NHS Trust said: "The trust recognises and acknowledges the problems with the hospital sterilisation and disinfection unit, which it has been actively working on since June.

"We acknowledge that we have made very slow progress with addressing the problems and have already slowed the process to ensure patient safety.

"The trust is working very hard to ensure that orthopaedic trauma surgery continues at the hospital."

Michael Mates, the local Conservative MP, met Gisela Stuart, the Health Minister, three times over the past two months to raise concerns about the problem.

He said: "I met the minister and she thanked me for possibly averting a crisis, but nothing has been done.

"I do not blame her, but I do blame the management team for being so slow to react; it is a disgrace."

Liam Fox, the Shadow Health Secretary, said: "This is a disgraceful situation, not least because ministers did know about it and failed to act.

"It is another example of Labour's obsession with spin and headlines at the expense of patients."

16 Nov 00 - Medicine - The race to buy life

James Meek, science correspondent

Guardian ... Thursday 16 November 2000

Carve up of the human heart: private firms, universities and charities are rushing to isolate and patent human genes before it is even understood what they do

The race for commercial control over the essence of life is threatening to spiral out of control with private firms, universities and charities claiming exclusive development rights over natural processes in the human body at the rate of 34,500 a month .

For the first time, research commissioned by the Guardian reveals the awesome scale of the gene rush, as investors, scientists, entrepreneurs and lawyers use powerful new technology and obscure new laws to isolate and patent the genes which make us what we are - before they even understand what the genes do.

Biotech firms say they need patent protection to recoup their investments. But the risk to society is that future medical researchers - private and public - will have to hack their way through forests of patents, paying out hefty licence fees to a host of gene-squatters , before the miracle drugs of the genetics revolution reach the market.

"It's like someone buying a street and taking a toll from everybody passing through ," said Thomas Schweiger, of German Greenpeace, which is campaigning against gene patenting.

Sue Mayer, head of GeneWatch UK, the independent watchdog body commissioned by the Guardian to analyse the gene patent rush, challenged the basis on which gene patents are granted - that genes, or bits of genes, are "inventions".

"What's striking is the speed and the scale at which patent applications are being made," she said. "It's impossible that this is caused by a sudden outbreak of creativity and inven tiveness. Unless people look at the issue seriously, unless the rules are changed in a few years time we will find very basic knowledge and information has been privatised."

Alongside human genes, patents are being sought by organisations, overwhelmingly from rich countries, on hundreds of thousands of animal and plant genes, including those in staple crops such as rice and wheat.

Patents are already pending or have been granted on more than 500,000 genes and partial gene sequences in living organisms .

When GeneWatch UK began its database search last month, patents had been granted or were pending on 126,672 whole or partial human genes . As of this week, however, that number had rocketed by over 34,500 to 161,195 , an increase of 27%.

• Gene patenters are overwhelmingly from the US , Western Europe and Japan .

Opponents of gene patenting believe companies using genetic information to develop real therapies and diagnostic techniques should be able to use the patent system to claw back the huge investment involved.

But they object to firms and other organisations being granted patents for genes when they cannot specify what the genes will be used for.

"Genes are isolated by computers on a routine basis," said Mr Schweiger. "There's no special intellectual work required. Even if the gene patenter doesn't ever develop a new drug or therapy with the gene, and somebody else does all the investment to find out what use can be made of the gene, all the investment is done by the second company and the first company still gets the money."

Concern is growing in continental Europe over an EU directive adopted two years ago which makes it easier to patent genes. In June, the French president Jacques Chirac wrote to the head of the European commission, Romano Prodi, saying that gene patenting should not be permitted .

Yet delegates to a rare diplomatic conference to revise the treaty governing European patent law, opening in Munich on Monday, are not even planning to discuss gene patenting . The British delegate, Alison Brimelow, said yesterday the issue would not be discussed until next year.

The British government has strongly supported liberalisation of the laws on gene patenting, hoping to nurture its own biotech industry and fearful the anti-GM backlash would persuade European and US biotech investors to relocate.

Much of the pressure to liberalise European gene patenting laws has come from the US . Last year the chairman of US drugs firm Pfizer, William Steere, said: "Europe seems to be entering a period of the dark ages, where witchcraft and sorcery are prevailing." The sentiment was shared by Andre Pernet, Genset chief executive. "I think the fear generated by the decoding of the human genome, that somehow people's 'essence' would be captured, has carried over into the gene patenting debate.

"You don't want to patent a gene and then just watch the patent time deadline melt away like a block of ice. There's no money to be made unless you really want to develop a drug."

16 Nov 00 - Medicine - 'Superbug' shuts hospital ward

Staff Reporter

Times ... Thursday 16 November 2000

A hospital ward has been cancelling new admissions for almost two weeks because of the "superbug" MRSA .

Tests on patients in the vascular ward at Ninewells Hospital, Dundee, showed that 11 out of 22 were carrying the bacterial infection, which has developed a resistance to antibiotics .

The hospital has brought in an extra team of nurses to treat those on the ward with MRSA in order to limit the spread of infection. A spokesman for Tayside University Hospitals Trusts said the action taken was precautionary and no patients had suffered adverse effects.

The ward treats patients who are having surgery on veins, usually on their arms or legs.

16 Nov 00 - Medicine - Here's a funny way to protect your heart

By Mark Henderson, Science Editor

Times ... Thursday 16 November 2000

THIS may sound funny, but scientists say that laughter is a good way of protecting yourself against a heart attack.

People who have had heart attacks, or who have been treated for heart disease, are up to 40 per cent less likely to laugh in various situations than those in normal health, according to research published by American cardiologists. The findings by researchers at the University of Maryland in Baltimore, which were presented yesterday to the American Heart Association, suggest that laughing when angry might offset the damage done to the arteries by stress.

Michael Miller, director of the Centre for Preventive Cardiology, who led the research, said: "We don't know why laughing protects the heart, but we do know that mental stress is associated with impairment of the endothelium, the protective barrier lining our blood vessels." More research was needed to find out if laughter released some as yet unidentified endothelial protectant, Dr Miller added.

16 Nov 00 - Medicine - Snack may beat blood problems in the air

By Our Science Correspondent

Times ... Thursday 16 November 2000

Air travellers should have a snack and a soft drink before boarding to cut the risk of "economy class syndrome" and other circulatory problems, scientists said yesterday.

Eating and drinking just before flying raises the volume of blood circulating in the body and can help to prevent heart attacks, fainting and deep-vein thrombosis, which have all been linked to long-distance air travel, a new study by Japanese researchers has found.

Low cabin pressure at high altitudes can cause blood vessels and organs to expand as the body seeks to increase its oxygen supply, the cardiologists from Saitama Medical School said. The amount of blood in the body, however, normally remains the same, leading to a relative reduction in oxygen supply and potential circulatory problems.

Makoto Matsumura, who led the study, said the answer could lie in a light but nutritious meal, to stimulate blood supply and circulation . "Most are probably doing it before boarding anyway."

14 Nov 00 - Medicine - Vaccine to fight hidden killer of babies

by Roger Highfield, Science Editor

Telegraph ... Tuesday 14 November 2000

Scientists are about to test the first vaccine to combat a disease that infects at least 700 babies each year in Britain, killing around 100 and causing brain damage in dozens more.

The misery caused by group B Streptococcus is as significant as spina bifida or muscular dystrophy, yet few people have heard of it, said Dr Robert Feldman, chief scientist of the Berkshire company Microscience, who has spent a decade trying to combat the bacterium.

Dr Feldman, a consultant at the Hammersmith Hospital, said he was surprised and concerned that the public was mostly unaware of the threat posed by the bacterium, which is much greater than meningitis. Nearly one fifth of unborn children infected with the bacterium die.

Vaccines work by training the body to recognise an invader so that an adequate immune response can be mounted when the real thing appears. Dr Feldman and his colleagues looked for the proteins on the surface of the organism that could stimulate a good immune response.

He approached the biotechnology entrepreneur Dr Chris Evans for help. Dr Evans, whose wife, Anne had been affected by the organism during her second pregnancy, provided the backing to set up Microscience in 1997 - a biotechnology vaccine company that is now addressing a range of infections, including typhoid , meningitis , strep throat and traveller's diarrhoea .

Dr Feldman's team at Microscience isolated a handful of the surface proteins that are common to all strains. Next, they isolated those that generated the biggest immune response. From these, they have now selected a single protein which can be mass produced. The first clinical trial of the protein vaccine, using healthy volunteers, is planned for next year, said Dr Feldman. "If we find antibodies that react with group B streptococci in the volunteers, then we have a good indication that the approach will work."

There is competition to develop the vaccine but Microscience is one of the few using proteins. Others have focused on sugar molecules that cluster around the organism, which have proved less successful at triggering an immune response.

Dr Feldman was instrumental in starting up the Group B Strep Support charity, which tries to raise awareness of the organism. The bacterium, which is carried by one third of the population, grows in chains so that under the microscope it looks like a string of pearls. It lives in a "privileged position" in the body and is impossible to eradicate, said Dr Feldman.

A quarter of all women carry the bug in the vagina . Sometimes, it can spread to the womb where it can infect the baby and trigger labour, occasionally causing stillbirths. Dr Feldman said: "By the time the baby is born they are very sick and grey. The bacterium almost always causes pneumonia and septicaemia .

Even though it responds to antibiotics, they are often used too late," he said, explaining that the dead organism remains toxic . Antibiotics are used during labour by some hospitals to treat at-risk women, such as those who have a history of the infection, or go into premature labour. Sometimes doctors are fortunate enough to detect the organism, but tests for carriers are not reliable and not conducted routinely.

Dr Feldman believes that the vaccine offers a better alternative to injecting women with antibiotics during labour, which is invasive and can cause side effects. Most importantly, he said, a vaccine could stop virtually all group B strep infections in babies.

13 Nov 00 - Medicine - Flu drug approved for risk patients

By Nigel Hawkes

Times ... Monday 13 November 2000

A Flu drug rejected by the National Institute for Clinical Excellence a year ago is likely to gain a partial reprieve.

The institute's revised advice, believed to be imminent, will say that Relenza can be prescribed on the NHS for patients at high risk of flu complications, such as the elderly and those with asthma and heart disease .

Industry confidence that Relenza will get this degree of approval is based on the fact that nobody, including the manufacturer, GlaxoWellcome, has objected to the revised guidance issued to interested parties last month.

Glaxo was furious about the institute's initial judgment, that the drug failed to show sufficient benefits to justify its use. Its silence since receiving the revised advice suggests that the institute has relented.

The delay in announcing the decision has enabled the NHS flu vaccination campaign to get under way. Fears had been expressed that those targeted for vaccination might hold back if told that Relenza were to be made available. Vaccination is still a better bet than Relenza, which is claimed to knock a few days off the course of the illness.

Scientists are proposing to recreate the lethal 1918 flu virus in the laboratory, a move that has divided the academic community.

Those in favour of rebuilding the virus, which killed 40m people worldwide in a single year, argue that it would provide vital information that could prevent a similar catastrophe . They fear that, without such research, the world is at risk of the recurrence of an equally virulent strain, which could occur at any time .

Scientists have already tried to understand why the 1918 virus, called Spanish flu, proved so lethal by digging up the bodies of dozens of victims deep-frozen in permafrost in Alaska and northern Norway. This exercise, however, has yielded only fragments of its eight genes .

Now many researchers believe the only way to unravel the secret of its virulence is to reconstruct it and observe how the various elements interact to make it "super-virulent". America's prestigious National Institutes of Health (NIH), which oversees the nation's medical research establishment, is planning an international conference to draw up an agreement on how such a virus should be handled.

The rules - also covering who has access - would be similar to the international agreement for the last existing samples of the smallpox virus, now held in only two laboratories.

Robert Webster, a leading expert on flu in Memphis, Tennessee, wants to synthesise the virus. He is to discuss plans with NIH tomorrow. "We need guidelines on what should and should not be done. It is theoretically possible to make any flu virus and some of these could be more lethal than the 1918 one."

Daniel Lavanchy, co-ordinator of epidemic disease control at the World Health Organisation in Geneva, is opposed to laboratory-made flu viruses, and questions whether it would be possible.

However, he is anxious about the need to understand the constantly mutating virus before it reappears in a new epidemic, or is seized upon as a weapon of bioterrorism .

11 Nov 00 - Medicine - Success in treating childhood epilepsy

Staff Reporter

BBC News ... Saturday 11 November 2000

Doctors have had success in treating a form of childhood epilepsy with a drug called stiripentol .

The drug has proved to be effective in trials when used to treat children with severe myoclonic epilepsy in infancy (SMEI) .

In children with SMEI, seizures appear during the first year of life and never come under complete control with conventional antiepileptic drugs.

All children develop mental retardation from the second year of life.

Stiripentol showed promise in treating SMEI in a previous trial when combined with two other drugs, clobazam and valproate .

To confirm these results, researchers from Hopital Saint Vincent de Paul in Paris carried out a new trial involving 41 children with SMEI.

The children were all given clobazam and valproate for one month.

Then half were also given stiripentol and half a placebo for a further period of two months.

The researchers found that during the third month of the trial the frequency of seizures was cut by at least half in 71% of the children who were given stiripentol .

Nine of these children suffered no seizures at all .

In comparison, the frequency of seizures was cut by half in just one (5%) child who was given a placebo.

Side effects

The 21 patients on stiripentol had moderate side-effects , including drowsiness and loss of appetite.

But the side effects disappeared when the dose of co-medication was decreased in 12 of the 21 cases.

Writing in The Lancet medical journal, the researchers stress that anti-epileptic drugs must be tested on children before it can be said for certain whether they will work, or are appropriate to administer.

Currently, many trials are only carried out on adults, and it assumed that the results apply to children.

They say: "The results obtained in adults cannot be extrapolated to children because some epilepsy syndromes do not exist in adults and tolerability can be different according to age."

The researchers also question the wisdom of testing drugs on all children with epilepsy without distinguishing between the differing forms of the condition.

There are different types of childhood epilepsies, caused by different factors, they say.

Consequently, it is likely that new drugs may have a beneficial effect on one type of epilepsy, and not another.

11 Nov 00 - Medicine - Doctors baffled by 50% cancer rise since 1971

By Jeremy Laurance, Health Editor

Independent ... Saturday 11 November 2000

Cancer is rising faster than can be accounted for by the ageing of the population and is likely to strike one in three of the population within their lifetime .

The growing burden imposed by the disease, up by half since 1971, is revealed in figures published yesterday by the Office for National Statistics (ONS). They show the number of new cancers diagnosed each year increased from 149,000 in 1971 to 221,000 in 1997, or a rise of 72,000 annual cases.

Reasons for the increase have baffled doctors , dismayed researchers and now threaten future generations despite the hundreds of millions of pounds spent looking for the causes of the disease. The rise threatens the government target of reducing cancer deaths by 100,000 in people under 75 by 2010.

Part of the rise is because of the ageing of the population and to improved data collection. Cancer is mainly a disease of the old and their numbers have grown sharply since 1971. Only 6 per cent of cancers among men and 9 per cent among women are in people under 45.

However, when the effect of the ageing population is taken into account, the figures show a real rise in the incidence of cancer of 20 per cent among men and 30 per cent among women since 1971 , which remains unexplained. Most of the increase has been in the elderly - there has been little change in incidence in men under 65 and women under 55.

Progress in treatment has also been limited. There are now one million people diagnosed with cancer. Although survival has improved greatly for some cancers, - such as breast and testicular - overall survival has improved little. While death rates from heart disease, stroke and infectious diseases have fallen heavily over the past 50 years, deaths from cancer have fallen only slightly.

As mortality from heart disease has dropped, cancer has overtaken it to become the country's biggest killer. The disease became the most common cause of death among women in 1969 and among men in 1995, according to the ONS.

Overall, the number of people dying from cancer rose from 116,000 a year in 1971 to 133,000 in 1999, a rise of 17,000. The death rate initially increased among women before falling slightly during the 1990s. Among men, the death rate has fallen slowly since the mid-1980s.

One of the fastest-rising cancers is breast cancer, up by 45 per cent in women aged 45 to 64, and by one-third in older women. However, the death rate from breast cancer has fallen by 20 per cent in the past decade, largely owing to increased use of the hormonal drug tamoxifen and partly due to breast screening.

Testicular cancer, which affects chiefly young men, has more than doubled but bettertreatment has dramatically cut the mortality rate to fewer than 100 deaths a year.

The ONS report, published in Health Statistics Quarterly, divides cancers by social class, and says there would be 20,000 fewer cases if the differences were eliminated. Of these 80 per cent are caused by smoking.

Cancers more common in the rich are breast, prostate, brain, blood (leukaemia), skin (melanoma), lymphatic system (non-Hodgkin's lymphoma) and testicle.

Cancers of the poor include lung, larynx, lip, mouth, oesophagus - all caused by smoking - and cervix, bladder, kidney, pancreas and stomach.

10 Nov 00 - Medicine - An aspirin a day poses health risk

James Meikle

Guardian ... Friday 10 November 2000

Millions of people who take aspirin regularly to help stave off heart disease or strokes may be doing themselves more harm than good , researchers warn.

Many over-50s who take the drug because of "granny's example" rather than their GP's advice, are nearly doubling their chances of suffering from ulcers and internal bleeding , which can lead to death, according to an analysis of 24 studies on aspirin involving 66,000 patients.

Even low doses over long periods can cause such serious damage that patients need to consider closely the trade-off between the possible benefits and harms, say Yoon Kong Loke and Sheena Derry, of the Radcliffe infirmary, Oxford, in the British Medical Journal.

They found that "about one in 100 patients taking aspirin over a 28 month period will experience a gastrointestinal haemorrhage . No evidence exists that dose reduction or the use of modified release formulations significantly lowers the risk." Their analysis of all studies over longer periods suggested that bleeding occurred in 2.5% of patients taking aspirin compared with 1.4% who were not.

Men over 50 and women after the menopause are frequently advised to take aspirin, which thins the blood, reducing the chances of thrombosis. But thinning the blood also increases the chances of bleeding.

Over the past 10 years doses recommended for such preventative therapy have been reduced from about 300mg a day to 75mg, while short treatments for headaches can involve 600mg to 900mg.

Martin Tranter, an anaesthetist at the Geneva University hospitals, Switzerland, in an editorial in the journal, says the message of the new paper was "there is no gain without pain" and "it may be more appropriate for some to eat an apple rather than an aspirin a day."

Scientists in the US says that a type of cholesterol-lowering drug may reduce the risk of people developing dementia by 70% .

The research team from Boston University School of Medicine say the implications of their findings, published in the medical journal The Lancet, is "considerable".

They say the the drugs could help delay the onset of dementia or inhibit the ageing process which impairs brain functions.

Dementia affects more than 700,000 of people in the UK, with Alzheimer's Disease accounting for 55% of cases.

Researchers studied the cases of more than 1,000 people over 50 from the UK-based General Practice Research Database, including 284 patients with dementia.

The study included people being treated for the condition hyperlipidaemia, where there is an excess of fats - one of which is cholesterol - in the blood.

Hyperlipidaemia is treated using lipid (fat) lowering agents (LLAs), including a class of drugs called statins .

The researchers compared the dementia patients with the 1,000 other patients and assessed the risk the latter had of going on to develop dementia.

They found that patients on statins had a 70% lower risk of dementia than people not diagnosed with hyperlipidaemia or those on other lipid-lowering drugs. Changes in lipid levels have been linked to dementia but experts do not yet understand how the two are associated.

Report author Dr Hershel Jick said: "We have shown that people in the UK who are prescribed statins have a risk of dementia, clinically diagnosed by GPs and their consultants, which to our best estimate is 70% lower than those who do not have hyperlipidaemia or who are not on LAAs.

10 Nov 00 - Medicine - Researchers warn over daily aspirin remedy

Staff Reporter

PA News ... Friday 10 November 2000

Doctors are being urged to think again before persuading patients threatened by heart disease to take a daily dose of aspirin.

The advice comes from researchers who found that even at very low doses , long-term use of aspirin carries a significant risk of internal bleeding .

A review pooling the results of 24 previous studies, involving nearly 66,000 patients, showed that on average 2.5% of people taking aspirin suffered from gastrointestinal bleeding .

This compared with a figure of 1.4% for patients not taking aspirin - almost double the risk. The average number of pills needed to do harm was 106 per year.

There was no evidence to indicate that switching to a low dose or taking a modified release formulation of aspirin lessened the chances of bleeding.

Gastrointestinal haemorrhage occurred in 2.3% of patients taking doses of below 163mg per day .

Aspirin is supposed to help people with heart problems because it helps to prevent blood clots.

The findings, from Yoon Kon Loke and Sheena Derry at the Radcliffe Infirmary, Oxford, appear in the British Medical Journal.

They indicate that about one in 100 patients taking aspirin over a 28-month period will experience an episode of gastrointestinal bleeding .

The researchers wrote: "Long-term therapy with aspirin is associated with a significant increase in the incidence of gastrointestinal haemorrhage. No evidence exists that reducing the dose or using modified release formulations would reduce the incidence of gastrointestinal haemorrhage."

08 Nov 00 - Medicine - Chemist chain puts cold cures away

James Meikle, health correspondent

Guardian ... Wednesday 8 November 2000

A high street chemist chain yesterday began withdrawing from public view all over-the-counter cold and flu remedies involved in a safety review , forcing customers to ask for the products through shop pharmacists.

Lloyds pharmacy, with 1,300 shops nationwide, said the measure was taken to safeguard consumers while government bodies checked on about a dozen products containing an ingredient linked to hundreds of strokes among young women in the US.

The products are usually displayed in cabinets behind counters and can be sold under special protocols by medicine counter staff. The com pany plans "as an interim extra safety measure" to put them into dispensaries, and customers requesting them will have a consultation with a pharmacist, who may suggest alternatives.

The chain sells 100,000 packs a year of Sinutab , 80,000 of Day Nurse , and 75,000 of Mucron , three of the best known names in the £10m a year UK market for products containing phenylpropanolamine (PPA ).

Boots withdrew an own-brand "prolonged relief" cold capsules, to avoid confusion with Boots products that do not contain PPA, but continued selling other branded products at its pharmacy counters. The Superdrug chain was also continuing to sell the products.

The committee on the safety of medicines will today review the situation in Britain, after the decision of the American food and drug administration to ask companies to withdraw products containing PPA .

Manufacturers promised to work closely with regulators. They pointed out that maximum intakes of PPA permitted in Britain were 100mg a day, compared with 150mg a day in the US. Appetite suppressants with the ingredient, commonly used by dieters in America, were not available here.

SmithKline Beecham, which makes Day Nurse and Contac 400 , said it was working with the medicines control agency (to which the CSM reports) and added: "Any review by any regulatory body has to look at the differences between conditions in diferent countries."

Pfizer, which makes Benylin Day and Night and Sinutab , said: "We will be guided by the medines control agency in the interests of consumers."

Decongestants containing PPA have been on sale for more than 20 years, and there have been two previous reviews of their use.

The Department of Health last night said packaging and leaflets already advised consumers that such products should not be used by those with high blood pressure , heart disease , diabetes , glaucoma and other conditions. The CSM would "advise the MCA of any further regulatory action which may be necessary".

New research on human embryos could lead to powerful new treatments for serious injuries and degenerative diseases , according to a new study by members of Britain's science elite.

The Royal Society, has become the latest body to back a controversial step : to take human embryos not needed in infertility research, and use cells from them to reverse the effects of disorders such as Parkinson's disease .

The government is expected to allow a free vote this autumn on changes to the 1990 Human Fertilisation and Embryology Act to give legal sanction to this controversial step, which could bring powerful new treatments for serious injuries and degenerative diseases.

Stem cell therapy seemed impossible until three years ago when (quite separately) Scottish scientists cloned Dolly the sheep from an adult cell, and US commercial scientists found a way to keep embryo stem cells alive in a culture. Stem cells are the precursors of the 200 kinds of skin, bone, blood, nerve, muscle and organ cell that make up a human.

The two discoveries raised immediate hopes of a new class of treatment. Scientists now believe they could put the nucleus of a patient's cell into an unfertilised egg, watch it divide and take from it the embryo stem cells that are the precursors of all human tissue. Then they would be able to tailor new "personalised" nerve stem cells for people with neurodegenerative diseases, or pancreatic stem cells for children with diabetes.

The proposal has been dubbed "therapeutic cloning" . It has alarmed anti-abortion campaigners and some who see it as a step toward the cloning of human beings.

A 10-minute rule private member's bill calling for embryo stem cell research, introduced by the Liberal Democrat MP Evan Harris, was roundly defeated last week. But the government is expected to make parliamentary time available for debate.

08 Nov 00 - Medicine - Chemists try to calm cold cure fears

By Celia Hall, Medical Editor

Telegraph ... Wednesday 8 November 2000

Chemists and drug companies sought to allay fears yesterday over a group of popular cold and flu remedies that has been linked in America to an increased risk of strokes in young women.

Boots and Lloydspharmacy have reminded their pharmacists that the remedies should not be sold to people with a history of heart disease or strokes .

The Department of Health has asked the Medicines Control Agency to investigate the safety of phenylpropanolamine, an ingredient commonly found in over-the-counter treatments including Day Nurse , Benylin Day & Night , Contac 400 and Vicks Coldcure , Sinutab and Mucron tablets.

Boots has withdrawn its own brand of prolonged release cold capsules which contained phenylpropanolamine , so it can now say that its own cold products are free of the substance.

Andy Murdoch, director of pharmacy at Lloydspharmacy, said they had removed some products from open display and put them behind the counter.

07 Nov 00 - Medicine - 'Magic wand' helps destroy cancer

by Zoe Morris, Health Reporter

Evening Standard ... Tuesday 7 November 2000

A technique for destroying breast cancer tumours with a single dose of radiotherapy has been developed by a leading London expert.

Professor Michael Baum has "cured" more than 30 women with the treatment, known as the "magic wand", which involves directing radiation into the breast while women undergo surgery.

The traditional treatment for breast cancer is an operation to remove the tumour followed by a gruelling six-week course of radiotherapy sessions to prevent it reap-pearing.

However, in a pioneering pilot project at University College London Hospital, 35 women have been given a single large dose of "intra-operative" radiation, which removes the need for post-operative sessions. If the technique eventually becomes standard treatment, it will also ease the pressure on radiotherapy services.

Initial trials of the 20-minute operation have proved the method is safe and cancer has not returned in any of the 35 women, although Professor Baum stressed it was "early days".

He said: "We have completed the pilot study with great results. There have been no adverse reactions. We have been very excited by the results but before it can become available on the NHS we need to do further tests."

Now Professor Baum is leading a study of more than a 1,000 women around the world including research in Bombay and Perth. It is hoped the breakthrough may offer hope to women in parts of the world where effective treatment has been denied in the past - either because they live too far from radiotherapy services or because of lack of equipment.

Linda Lines, 54, an executive director of a financial management group in the City, is one of those to benefit from the trial. She underwent the "magic wand" treatment at the Middlesex Hospital last year.

Ms Lines said: "I felt a bit of a fraud. I thought to myself, 'This is marvellous but have I really had it?' I could live to a ripe old age thanks to one day of treatment. I feel wonderful." Her story will be told on Tomorrow's World tomorrow.

She is now on the drug Tamoxifen , which has been extremely successful at preventing breast cancer from returning, and has to have a check-up every three months.

More than 34,000 women a year in Britain are diagnosed with breast cancer. In nine out of 10 cases where cancer returns, it occurs at the site of the original tumour .

Professor Baum hopes the results of the worldwide trial will be available within five years, after which time it may become the standard treatment across the globe.

07 Nov 00 - Medicine - Remedies for colds linked to strokes

James Meikle and Rebecca Allison

Guardian ... Tuesday 7 November 2000

The government is reviewing the safety of over-the-counter cough and cold treatments following US fears over one of their key ingredients .

The products will remain on sale but the Department of Health last night advised concerned members of the public to contact their GP or chemist.

The alarm was raised after the American food and drug administration determined that an ingredient called phenylpropanolamine (PPA) , used in drugs to suppress patients' appetites was unsafe. It has been linked to the deaths of between 200 and 500 people under 50 in the US.

The Department of Health said last night: "These concerns have been raised in the states because PPA is used at very high levels in appetite suppressants. At a much lower level, it is used in cough and cold medicines. The amount of ingredient manufacturers are allowed to use in this country is much lower.

"Having said that, we have asked the MCA to conduct a review of the safety of PPAs, discuss their use with the FDA and report to us as quickly as possible."

Medicines would remain on sale for the time being and people should not feel "unduly concerned" but a department spokesman added: "If anybody is concerned, they should discuss it with their pharmacist or GP and they will get the best possible advice."

The department said the ingredient was not available as an appetite suppressant in this country in an over-the-counter product.

The FDA's action came two weeks after a scientific advisory committee reviewed a new study that made a connection between PPA and an increased risk for stroke, especially in young women .

The committee advised that PPA could no longer be "generally recognised as safe" according to the results of the study by Yale University.

The drug industry has generally fought the FDA regarding the safety of phenylpropanolamine , arguing that it has been used for decades and that evidence of a possible risk is unconvincing.

Bu the recent test findings are in line with other research going back 20 years, suggesting there might be problems. It showed that people aged 18 to 49 who took PPA had a small increased risk of stroke .

American consumers were yesterday advised to avoid certain products until the ingredient has been replaced and to check labels carefully. "We don't want to be alarmist, but it is important for consumers to know there are real risks associated with taking this ingredient. The adverse effects are rare, but they can be fatal while the conditions treated by the ingredient are not," said Charles Ganley, director of the FDA's non-prescription drug division. He said the FDA's action was not a recall, but a request for drug companies to voluntarily take products with PPA off the market. The agency would propose a formal new rule limiting the use of PPA.

It is the second review to be called by the British government in a week following a FDA verdict. Food standards chiefs and veterinary advisers are checking the safety of Baytril, a medicine used on poultry because it contains an antibiotic that appears to generate resistance in humans to drugs designed to fight food poisoning.

07 Nov 00 - Medicine - Cold remedy ingredient to be banned in US

Staff Reporter

Independent ... Tuesday 7 November 2000

The United States Food and Drug Administration (FDA) has advised Americans not to use dozens of over-the-counter cold remedies or appetite suppressants until their makers replace an ingredient that could cause strokes , especially in young women .

The ingredient, called phenylpropanolamine or PPA , is found in many products. But levels of the drug in American products are said by experts to be far higher than the ones in their British equivalents.

The FDA said it is taking steps to formally ban PPA , but meeting the legal requirements will take a few months. Meanwhile the agency has written to manufacturers asking them voluntarily to immediately cease selling products containing the ingredient.

At least one manufacturer has told retailers to remove a PPA-containing cold remedy, Contac 12-hour Cold Capsules , from store shelves. Five other versions of Contac contain an alternative ingredient, pseudoephedrine, that is safe, stressed manufacturer SmithKline Beecham Consumer Healthcare. It urged consumers to call a hot line if they're confused about the risk.

The risk of a hemorrhagic stroke , or bleeding in the brain, is very small to an individual user. But with millions of Americans swallowing PPA every day, the FDA determined the ingredient could be to blame for 200 to 500 strokes just in people under age 50 - those who typically are too young to be at risk for strokes.

"We suggest you stop taking the drug immediately and use an alternative," says an FDA warning issued for consumers.

Consumers should check the ingredient list of all nonprescription cold relievers for PPA and avoid those products, the FDA said. Instead, they could use cold pills containing the ingredient pseudoephedrine, or use nasal sprays.

However, PPA is the only nonprescription diet ingredient on the market. There are prescription weight-loss drugs, so dieters should consult their physicians about their options, said FDA nonprescription drugs chief Dr. Charles Ganley.

Drug manufacturers had fought the FDA's decisions, arguing that concern over the decades-old ingredient was overblown. But in a public hearing less than three weeks ago, FDA's scientific advisers dealt manufacturers a blow by voting unanimously that PPA is unsafe.

Drug companies were scrambling Monday to decide how to react to FDA's request. The maker of the largest-selling nonprescription diet pill, Dexatrim, Chattem Inc., refused comment.

Hemorrhagic strokes, while the least common type of stroke, often are deadly and can leave survivors disabled. They are very rare in people under age 50; the risk rises with age, as well as with high blood pressure, smoking, alcohol and use of blood-thinning medicines.

Doctors' first warning sign about PPA came in the 1980s when medical journals cited several dozen puzzling cases of young women who suddenly had strokes within days of taking appetite suppressants.

The FDA's own records show 44 cases of hemorrhagic stroke among PPA users in the past 30 years. Most were women; the median age was 35 .

But the drug industry successfully argued more research was needed to prove if PPA was to blame. So the Consumer Healthcare Products Association funded a five-year study by Yale University comparing 702 hemorrhagic stroke survivors under 50 with 1,376 similar "controls" who had never suffered a stroke. The goal was to see if PPA use was more common among stroke sufferers than among healthy people.

The study found PPA increases stroke risk for young women - not men - under two circumstances: within three days of taking PPA-containing appetite suppressants, or within three days of taking their first-ever PPA dose for any reason.

07 Nov 00 - Medicine - Family cold cures linked to strokes

By David Charter, Health Correspondent

Times ... Tuesday 7 November 2000

Ministers ordered an urgent inquiry last night after a drug found in many cold and flu remedies was linked to hundreds of strokes among young women and banned in the United States .

Over-the-counter medicines such as Benylin Day & Night , Contac 400 , Day Nurse , Sinutab and Vicks Coldcure contain phenylpropanolamine (PPA ), which has been licensed for use for more than a decade.

The withdrawal of such medicines in America comes after years of legal and scientific wrangling over PPA, which is also found in appetite suppressants. Scientific advisers to the Federal Drugs Administration (FDA) unanimously voted last week that it should no longer be considered safe, after it was the subject of a study by scientists at Yale University.

American consumers have been warned to avoid all products containing PPA , but it will all remain on sale in chemists here while British officials review the evidence.

The Department of Health announced its own inquiry last night, but stopped short of calling on products to be withdrawn . "We are aware of the situation in America and the Committee on the Safety of Medicines are reviewing the situation in the UK and will make recommendations," a spokeswoman said. "Patients with concerns about products containing PPA should contact their pharmacist." She advised a careful reading of each product's labels, which already advise against their use by people with high blood pressure or hypertension.

A spokesman for SmithKline Beecham, which is voluntarily withdrawing its products in America , said it was in talks with the Medicines Control Agency (MCA) over the future of Contac 400 and Day Nurse Capsules and Liquid . Pfizer, which makes Benylin ,said there was no cause for alarm or panic on the basis of one survey; PPA was effective and had been used safely for quite some time.

In America, PPA is said to have been responsible for between 200 and 500 strokes a year in people aged under 50 . The risk linked to PPA was a problem and is a concern, Charles Ganley, who oversees the FDA's division of over-the-counter drug products, said.

"We don't want to be alarmist. It is a very rare occurrence, but when you develop it, it could be devastating, causing disability or death."

Ninety-eight per cent of PPA doses sold in America last year were in cough and cold products, with the remaining 2 per cent in diet drugs.

The FDA said it had started the formal process of banning PPA, but in the meantime had written to ask manufacturers to stop selling products containing the ingredient.

Haemorrhagic strokes, while the least common type of stroke, often are deadly and can leave survivors disabled. They are very rare in people under age 50, with the risk rising with age, high blood pressure, smoking, alcohol and use of blood-thinning medicines.

The first warning sign about PPA came in the 1980s when medical journals cited several dozen puzzling cases of young women who suddenly had strokes within days of taking appetite suppressants.

The FDA's own records show 44 cases of haemorrhagic stroke among PPA users in the past 30 years. Most were women; the median age was 35 .

But the drug industry successfully argued that more research was needed to prove if PPA was to blame, so the Consumer Healthcare Products Association funded a five-year study by Yale University comparing 702 haemorrhagic stroke survivors under 50 with 1,376 similar controls who had never suffered a stroke.

The study found that young women - not men - were at increased risk of stroke within three days of taking PPA-containing appetite suppressants, or within three days of taking their first PPA dose ever.

But scientists who spoke on behalf of the non-prescription drug industry at the FDA hearing three weeks ago insisted that the Yale study was flawed and said PPA was safe and effective when used according to label directions.

07 Nov 00 - Medicine - Jab fears raise risk of measles

By Nigel Hawkes

Times ... Tuesday 7 November 2000

Children are growing up without protection against potentially fatal infections because of scares over MMR vaccine , the millennium medical conference in London was told yesterday.

The vaccination level in some areas has fallen so far that it was "almost at a stage where transmission of measles is sustainable" , said Angus Nicol, of the Public Health Laboratory Service's Communicable Disease Surveillance Centre in London. "That's a matter of concern," he said.

Dr Nicol said there were 14 districts in Britain where vaccinations had fallen to a dangerous level . He refused to name them, but said that London was "the most risky place" .

The low take-up level combined with the risk of diseases travellers bring to the capital from abroad made London "a rotten place to avoid measles immunisation", he stated.

The latest figures show a continuing fall in MMR vaccination, prompted by fears that it may be linked to autism and Crohn's Disease . A detailed study by Dr Nicol's centre has shown no evidence of any link with autism, and other studies have failed to demonstrate a link to Crohn's Disease.

The figures for the second quarter of the year show that 88.3 per cent of babies received their first MMR, which protects against measles, mumps and rubella, by the age of two. However, in London the take-up is just over 80 per cent, and that for the second vaccination, due by the age of five, is even lower. The national average is 74.8 per cent, down 1.2 per cent from the previous quarter. In London it is only 61.5 per cent.

06 Nov 00 - Medicine - Cancer test breakthrough

By Linus Gregoriadis

Times ... Monday 6 November 2000

A Simple blood test has been developed which can detect a wide range of cancers before there are any symptoms, it was claimed yesterday .

The early warning test, which was devised by scientists in America and gives results in 24 hours , is reported to be 84 per cent effective . Mary Berrington, of the Cancer Research Campaign, described the test as a potential "holy grail" of cancer diagnosis . Regular screenings could dramatically cut cancer death rates .

The test, which costs about £50 , can detect 13 types of the disease including cancer of the liver, lungs, ovaries, breast and cervix. It takes blood from a vein and checks for an antibody called DR-70 , which is produced by the body during very early stages of cancer.

It was developed by AMDL , the Californian biotechnology company, and has been approved for sale in Canada . Restricted sales began in the United States last May. Clinical trials in Canada, Taiwan, China and Turkey found the test to be effective.

06 Nov 00 - Medicine - Medical Briefing - Lose weight and stay fit

Dr Thomas Stuttaford

Times ... Monday 6 November 2000

Diabetes has reached epidemic proportions . In the UK alone nearly three million people can be expected to have diabetes by 2010 . Any child born today will have a one in ten chance of developing it. At present 95,000 cases are diagnosed in the UK each year, about one every five minutes .

The acute type 1 variety usually affects young people, who are often thin and very possibly athletic. Type 1 diabetes is an auto-immune disease also known as insulin dependent diabetes because it invariably must be treated with insulin.

About 85-90 per cent of cases diagnosed in the UK are the result of type 2 diabetes - also known as non-insulin dependent diabetes. These people are usually older, plumper and take less exercise. It is more common in those of African or Asiatic origin.

The report by the International Diabetic Foundation emphasises the importance of prevention by reducing obesity and increasing exercise . Several pharmaceutical preparations are also being introduced that may reduce insulin resistance, and therefore the load on the beta cells and pancreas.

Even the most rigorous of diets, together with a well-maintained regime of regular exercise, will not overcome the problem of insulin resistance, and type 2 diabetes, in people with a strong family history.

The early diagnosis of type 2 diabetes remains an important aim. Its symptoms are initially very ill-defined: the patient may notice no more than a loss of energy and extreme tiredness, and unlike those experiencing acute diabetes are unlikely to be troubled in the early stages of the disease by urinary frequency.

Fifty per cent of patients with type 2 diabetes already have evidence of arterial disease when it is diagnosed. Early diagnosis may be possible if greater reliance is placed on diagnostic blood tests.